Annals of Pharmacotherapy has reported a pediatric case of pegfilgrastim-induced hyperleukocytosis.
A 3-year-old boy with medulloblastoma therapy presented with white blood cell (WBC) count 0.1 x 103/µL and absolute neutrophil count (ANC) 0.014 x 103/µL on day 27 following a course of induction chemotherapy. The patient received pegfilgrastim 200 µg/kg the following day. On his return 6 days later for the next planned course of chemotherapy, hyperleukocytosis was determined, with WBC 149 x 103/µL and ANC 110 x 103/µL ("neutrophil overshoot"). No sources of the elevated WBC count other than administration of pegfilgrastim (eg, steroids, antiepileptics, infection) were present. Chemotherapy was delayed until the WBC count had fallen to 35.2 x 103/µL (ANC 28.9 x 103/µL). No sequelae from this adverse effect occurred.
Use of the Naranjo probability scale suggested that pegfilgrastim was the probable cause of hyperleukocytosis in the patient.
Source: Annals of Pharmacotherapy 2007;41(9):1524-1530.
http://www.theannals.com/cgi/content/abstract/41/9/1524
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